| NPI | 1962009225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant (Licence: WV 1568796027) |
| Additional Taxonomies | 376J00000X Homemaker (Licence: WV 1568796027) |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2021-12-22 |